Deep Transverse Lateral Retinaculum Reconstruction for Medial Patellar Instability  Vicente Sanchis-Alfonso, M.D., Ph.D., Erik Montesinos-Berry, M.D., Joan Carles Monllau, M.D., Ph.D., Jack Andrish, M.D.  Arthroscopy Techniques  Volume 4, Issue 3, Pages e245-e249 (June 2015) DOI: 10.1016/j.eats.2015.02.003 Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Once the subcutaneous tissue has been dissected, there is only a thin layer present that represents the lateral capsule and the remaining scar of the lateral retinaculum. (B) Frequently, we find a sectioned vastus lateralis tendon (arrow). Figure 1A reprinted with kind permission of Springer Science+Business Media.1 Arthroscopy Techniques 2015 4, e245-e249DOI: (10.1016/j.eats.2015.02.003) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) The anterior half of the iliotibial band is detached from the Gerdy tubercle (arrow). (B) If there is some manner of attenuated lateral retinaculum remaining, an interval is developed between the lateral capsule and the retinaculum. Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 2010-2015. All Rights Reserved. Arthroscopy Techniques 2015 4, e245-e249DOI: (10.1016/j.eats.2015.02.003) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) The strip of iliotibial band is brought through the interval to be attached to the lateral border of the junction of the middle and proximal thirds of the patella. It is not necessary to attempt attachment using a drill hole. (B) Our goal is to make the transferred tendon transversely oriented and attach it to the remaining intact iliotibial band at the level of the lateral femoral epicondyle. To do so and to adjust and establish tension, a series of sutures are placed, reattaching the posterior border of the transferred tendon to the anterior border of the remaining intact iliotibial band. We begin this at the proximal location of the prepared graft, working distally until the desired orientation and tension of the transfer have been achieved. Often, there will be a kink or wrinkle at the anterior bend of the transfer. In this case we will place 1 additional suture (arrow) within this fold and attach it to the posterior border of the remaining lateral retinaculum to release the fold. Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 2010-2015. All Rights Reserved. Arthroscopy Techniques 2015 4, e245-e249DOI: (10.1016/j.eats.2015.02.003) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions